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ERIKA VILLANUEVA M.D.
NPI 1861718223
Internal Medicine - Endocrinology, Diabetes & Metabolism in Pennington, NJ

Active since April 10, 2010PECOS EnrolledAccepts Medicare Assignment
95.77/100
CMS Quality Rating
2 CAPITAL WAY STE 290, PENNINGTON, NJ 08534(609) 303-4300(609) 303-4301 Get Directions Write a Review

NPPES record last updated: April 22, 2021. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Apr 22, 2021, Mar 17, 2018, Aug 22, 2017 and 1 more (4 updates tracked since 2017).

About Erika Villanueva M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ERIKA VILLANUEVA M.D. (NPI 1861718223) is an individual endocrinology, diabetes & metabolism provider in Pennington, New Jersey, licensed in New Jersey (25MA10117600) and active in the NPI registry since April 2010. She is enrolled in Medicare PECOS, is affiliated with Capital Health Medical Center - Hopewell, and maintains a secondary practice location in New York.

NPPES Registry Identity

NPI1861718223
Entity TypeIndividualFemale
Primary Taxonomy207RE0101X
Provider Legal NameERIKA VILLANUEVACredential: M.D.
Location Address2 CAPITAL WAY STE 290Pennington, NJ 08534-2521
Mailing Address2 Capital Way Ste 290Pennington, NJ 08534-2521 · (609) 303-4300 · Fax (609) 303-4301
Phone(609) 303-4300
Fax(609) 303-4301
Sole ProprietorYes
Medical School CMSRutgers New Jersey Medical SchoolGraduated 2010
Enumeration DateApril 10, 2010
Last NPPES UpdateApril 22, 20214 updates tracked since enumeration
NPPES CertifiedApril 22, 2021
✔ NPI 1861718223 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyInternal Medicine · Endocrinology, Diabetes & MetabolismAllopathic & Osteopathic Physicians
Taxonomy Code207RE0101X
Licenses✔ Licensed in NJ · 25MA10117600✔ Licensed in NY · 269981
Definition
An internist who concentrates on disorders of the internal (endocrine) glands such as the thyroid and adrenal glands. This specialist also deals with disorders such as diabetes, metabolic and nutritional disorders, obesity, pituitary diseases and menstrual and sexual problems.
Also ListedClinic/CenterTaxonomy 261Q00000X · License 269981 (NY)
Also ListedGeneral Acute Care HospitalTaxonomy 282N00000X · License 269981 (NY)
2 CAPITAL WAY STE 290, Pennington, NJ 08534
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Secondary Practice Location 1

Location 1207 E 84th StNew York, NY 10028-2972 · Phone (646) 754-3300

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter Health, Ambetter Health of Delaware, Oscar Health.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Erika Villanueva M.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID3072834209
PECOS Enrollment IDI20170822002252
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Erika Villanueva reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Capital Health Medical Group
7.2 mi
Internal Medicine
750 BRUNSWICK AVE
Trenton, NJ 08638
  • Reassigned Medicare billing, New Jersey enrollment
  • 581 clinicians in this Medicare group
NPI 1437516887 (609) 815-7829

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 6

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
290 services149 patients
Blood glucose (sugar) test performed by hand-held instrument 82962
A blood glucose test uses a handheld device to measure the amount of sugar in your blood. A small prick on your finger allows a drop of blood to be placed on a test strip, which is then read by the device. This helps monitor and manage diabetes effectively.
200 services96 patients
Continuous monitoring of blood sugar level in tissue fluid using sensor under skin with interpretation and report 95251
This procedure involves placing a small sensor under your skin to continuously monitor your blood sugar levels in tissue fluid. The data is interpreted and a report is generated to help manage your diabetes more effectively.
66 services32 patients
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes 99233
Follow-up hospital inpatient care per day typically involves a 35-minute check-up by your healthcare provider. This service includes monitoring your health progress, adjusting your treatment plan if needed, and answering any questions you may have about your condition or care.
43 services25 patients
Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes 99223
Initial hospital inpatient care per day, typically 70 minutes, refers to the daily medical service provided to patients admitted to the hospital. This includes a comprehensive evaluation, diagnosis, treatment plan, and monitoring of your health condition. It ensures your well-being during your hospital stay.
14 services14 patients
Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional 99211
This service involves an outpatient visit for established patients who may not need direct interaction with a healthcare professional. It could include reviewing test results, monitoring existing conditions, or adjusting treatment plans. It's typically done remotely, ensuring your comfort and convenience.
13 services11 patients

Hospital Affiliations CMS Care Compare 2

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Capital Health Medical Center - Hopewell

Acute Care Hospitals · Pennington, NJ
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number310044
LocationOne Capital WayPennington, NJ 08534 · Mercer County
Emergency services Birthing friendly

Capital Health Regional Medical Center

Acute Care Hospitals · Trenton, NJ
1/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number310092
Location750 Brunswick AveTrenton, NJ 08638 · Mercer County
Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 08534 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$140.34 typical visit price
range $61.59 – $185.05
Typical copayment $35.08 (range $15.39 – $46.26)
Most-billed visit code 99204
Established Patient
$107.94 typical visit price
range $20.08 – $150.98
Typical copayment $26.98 (range $5.02 – $37.74)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

95.77/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored through an Alternative Payment Model
Quality76.75
Promoting Interoperability100
Improvement Activities40

Reported Quality Measures

Documentation of Current Medications in the Medical Record
Percentage of visits for patients aged 18 years and older for which the eligible professional or eligible clinician attests to documenting a list of current medications using all immediate resources available on the date of the encounter.
100%1,644 patients5/55-star benchmark: 100%
e-Prescribing
At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology.
98%3,177 patients4/55-star benchmark: 99%
Falls: Screening for Future Fall Risk
Percentage of patients 65 years of age and older who were screened for future fall risk during the measurement period
99%214 patients5/55-star benchmark: 99%
Medication Reconciliation
The MIPS eligible clinician performs medication reconciliation for at least one transition of care in which the patient is transitioned into the care of the MIPS eligible clinician.
99%173 patients4/55-star benchmark: 100%
Patient-Specific Education
The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician.
79%917 patients4/55-star benchmark: 97%
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan
Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous twelve months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous…
70%750 patients3/55-star benchmark: 97%
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received tobacco cessation intervention if identified as a tobacco user
Patients screenedForUse: 99% · 472 patients
Patients tobacco: 21% · 28 patients
94%470 patients4/55-star benchmark: 98%
Provide Patient Access
At least one patient seen by the MIPS eligible clinician during the performance period is provided timely access to view online, download, and transmit to a third party their health information subject to the MIPS eligible clinician's discretion to withhold…
83%917 patients4/55-star benchmark: 100%
Secure Messaging
For at least one unique patient seen by the MIPS eligible clinician during the performance period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure…
36%917 patients2/55-star benchmark: 89%
View, Download, or Transmit (VDT)
At least one patient seen by the MIPS eligible clinician during the performance period (or patient-authorized representative) views, downloads or transmits their health information to a third party during the performance period.
48%917 patients
Providers report different measures because they deliver different services; reporting more or less information is not a reflection of quality. Star ratings appear only where CMS assigned them.

Referred Medical Equipment & Supplies CMS DME claims 4

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Supply allowance for adjunctive continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service A4238
DME-Medical/Surgical Supplies · category DA000N
2 suppliers12 claims12 services$170.67 avg. paid by Medicare
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253
DME-Other DME · category DE017N
31 suppliers81 claims310 services$6.09 avg. paid by Medicare
Lancets, per box of 100 A4259
DME-Medical/Surgical Supplies · category DA000N
19 suppliers37 claims58 services$1.05 avg. paid by Medicare
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service K0553
DME-Other DME · category DE017N
8 suppliers196 claims199 services$191.21 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

NAZISH AHMAD M.D
Internal Medicine (Endocrinology, Diabetes & Metabolism)
2 CAPITAL WAY STE 290
PENNINGTON, NJ 08534
Mercer County (609) 303-4300
JOANNA LYNN TOLIN MD
Internal Medicine (Endocrinology, Diabetes & Metabolism)
2 CAPITAL WAY STE 290
PENNINGTON, NJ 08534
Mercer County (609) 303-4300
VIVIAN PHUNG APN
Nurse Practitioner
2 CAPITAL WAY STE 290
PENNINGTON, NJ 08534
Mercer County (609) 303-4300
ERIN ALYSE SALTZMAN MD
Internal Medicine (Endocrinology, Diabetes & Metabolism)
2 CAPITAL WAY STE 290
PENNINGTON, NJ 08534
Mercer County (609) 303-4300

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Erika Villanueva's NPI number?

The NPI number for Erika Villanueva is 1861718223. It was assigned to this individual provider in the NPPES registry on April 10, 2010.

Where is Erika Villanueva located?

Erika Villanueva practices at 2 Capital Way Ste 290, Pennington, NJ 08534. The listed phone number is (609) 303-4300.

What is Erika Villanueva's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Endocrinology, Diabetes & Metabolism, with taxonomy code 207RE0101X.

Is Erika Villanueva enrolled in Medicare?

Yes. Erika Villanueva is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organization bills Medicare for Erika Villanueva's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Erika Villanueva reassigns Medicare benefits to Capital Health Medical Group (Trenton, NJ). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Erika Villanueva's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Erika Villanueva accept?

Health plans from Ambetter Health, Ambetter Health of Delaware and Oscar Health list Erika Villanueva as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Erika Villanueva affiliated with any hospitals?

According to CMS data, Erika Villanueva is affiliated with Capital Health Medical Center - Hopewell and Capital Health Regional Medical Center.

When was this NPI record last updated?

The NPPES record for Erika Villanueva was last updated on April 22, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.